Clinical efficacy and safety of cefiderocol for resistant gram-negative infections: a real-life, single center experience

Unlabelled: : Cefiderocol is a 'siderophore' cephalosporin active against Gram-negative bacteria, including carbapenem-resistant strains. Data on the use of cefiderocol in real life are limited. We evaluated the efficacy and safety of cefiderocol in the context of our hospital clinical practice. Methods: This was a single center, observational, retrospective clinical study. We collected data of all patients who received cefiderocol therapy in our Hospital, with a focus on clinical outcomes and adverse events. Results: The study cohort included 28 patients, with a median age of 73 years [25-83] and a high burden of comorbidities. Up to 45 gram-negative isolates were grown from the study patients, the most common pathogen being Acinetobacter baumannii (31.1%). Cefiderocol was mostly prescribed for pneumonia (37.8% of cases), bloodstream (24.4%), urinary tract (22.2%), and intra-abdominal infections (20%), and largely as salvage therapy (92.8%). 14 (77.8%) of the 18 patients for whom follow up cultures were available achieved eradication of the causative microorganism. Therapeutic success (improvement/resolution of the infection) occurred in 64.28% at 7 days and 50% at 14 days from treatment start. Treatment failed in 9 cases (32.1%). No effects on kidney, liver or bone marrow function were observed. Conclusions: Cefiderocol showed a fair efficacy and excellent tolerability in highly comorbid patients with a range of multi-resistant infections. It may be an option for infections due to colistin-resistant pathogens, when other regimens fail or in cases at risk of kidney dysfunction.